Diabetes distress, women's kidney care, and a fall-prevention plan for cirrhosis

Two diabetes documents published on September 15 and 16 move the emotional side of the condition and the devices that manage it to the center of adult care. An American Heart Association statement published September 17 says kidney disease in women is being found late. A trial published September 16 tested a familiar liver medicine against falls, which people with cirrhosis name as an unmet need and a care priority. A cohort study published September 18 followed 85,554 people for a decade to see what happened to their livers when their drinking fell and stayed down.

The summaries below are background for your next appointment. Your clinician knows your history, your test results, and your current prescriptions, and treatment decisions belong in that conversation.

On September 15, the American Diabetes Association and the European Association for the Study of Diabetes published an updated consensus report on managing type 1 diabetes in adults, replacing the version the two organizations issued in 2021. 1 The 2026 report places particular emphasis on integrating new technology — for adults with type 1 diabetes, continuous glucose monitors and automated insulin delivery systems. The authors widened its scope to take in screening for the complications that build quietly over decades, the management of obesity, and cardiovascular risk factors. They added the newer treatments that can postpone stage 3 type 1 diabetes, the point at which symptoms appear and insulin from outside the body becomes necessary. Diabetes self-management education and support, and care for the emotional side of the condition, remain central to the plan.

The same day, Diabetologia published the other half of the week's diabetes news: the first evidence-based clinical practice guideline on diabetes distress, issued by the European Association for the Study of Diabetes. 2 The guideline defines diabetes distress as the emotional burden that comes with living with diabetes and managing it day to day. It asks care teams to handle that burden the way they handle blood pressure: measure it, record it, and follow it over time.

Eight good-practice statements set out what that looks like — routine discussion of emotional well-being, the use of validated questionnaires, ongoing monitoring, care planned together with the patient, the conversation documented in the record, and psychological support available when it is needed.

Where the evidence supported a formal recommendation, the panel found that psychological interventions, continuous glucose monitoring, and automated insulin delivery can each reduce distress in adults with type 1 diabetes, and that psychological, psychoeducational, and educational programs can do the same for adults with type 2 diabetes. The panel labeled those recommendations conditional: the balance of benefits and harms can shift from one person to the next, so the choice belongs with the clinician and the patient. The guideline also states its own limits: high-quality trials are scarce, particularly in low- and middle-income countries, and the panel worked only from randomized evidence.

The practical version of this guidance is small and specific. A distress questionnaire takes a few minutes, and the guideline wants the conversation to be routine, repeated on a regular schedule. If you use a sensor or a hybrid closed-loop system, the guideline counts those devices as part of emotional care as well as glucose control. If you have type 2 diabetes, structured education is the intervention with the strongest support behind it.

Ask at your next visit: "Could we go through a standard questionnaire on how diabetes is affecting me emotionally, and what support can I get if the score is high?"

On September 17, the American Heart Association published a scientific statement in Circulation called "Women's Kidney Health in Focus." A scientific statement gathers what is known about a topic and feeds the guidelines that follow it. 3

Chronic kidney disease affects about one in ten women worldwide. The statement's argument is about timing. Women are less likely than men to receive a kidney transplant, and worldwide men receive them about 30 percent more often. Women also tend to begin dialysis when their kidneys have less function left, which the writing group reads as delayed treatment. 4

Part of that delay sits inside the standard test. Kidney function is usually estimated from creatinine, a waste product that muscle makes. Women carry less muscle on average and may produce less creatinine, so the calculation can suggest healthier kidneys than the person has. The statement asks clinicians to account for that difference when they read results, and asks researchers to run studies with enough women in them to report findings by sex.

Life stages carry information too. For a woman who already has chronic kidney disease, pregnancy can push the disease forward and raise the odds of pregnancy complications; the statement suggests getting blood pressure, blood sugar, and weight under control before conception. For a woman whose kidneys are healthy, a complication such as preeclampsia during pregnancy signals a higher chance of kidney disease, heart disease, and stroke later in life. Natural menopause before age 45 and surgical removal of the ovaries before age 50 each track with higher kidney disease risk. So do polycystic ovary syndrome and lupus, which is more common in women than in men. Diabetes remains the leading cause of chronic kidney disease worldwide.

Two tests carry most of the information here: an estimated glomerular filtration rate (eGFR) from a blood sample, and a urine albumin-to-creatinine ratio (UACR) from a urine sample. Ask when yours were last checked, and mention preeclampsia, an early menopause, PCOS, or lupus if any of them apply to you.

Ask at your next visit: "When were my eGFR and urine albumin last measured, and does my pregnancy history or the age I reached menopause change how often they should be checked?"

Falls are common in cirrhosis and often serious, and people with the condition have named fall prevention as an unmet need and a care priority. On September 16, Hepatology published a trial that tested one familiar medicine against that problem. 5

LiveSMART enrolled 230 adults with cirrhosis and portal hypertension, the raised pressure in the vein that carries blood from the gut into the liver. The trial excluded anyone who had already had overt hepatic encephalopathy, the confusion that advanced liver disease can bring on. Four centers in Michigan, Pennsylvania, and Texas ran the trial for 24 weeks, in two stages of 12 weeks each. In the first stage, participants were assigned either lactulose, a prescription laxative that liver doctors already use to prevent hepatic encephalopathy, or enhanced usual care: education about nutrition and fall prevention. In the second stage, they were assigned either TeleTai-Chi, a tai chi program delivered over video, or education about exercise.

The results favored treatment. Participants who took lactulose and then joined the tai chi program had injurious falls at a rate of 4 percent, against 12 percent for those who received education alone, and falls without injury at 19 percent against 32 percent. Lactulose on its own showed the same direction: users had fewer injurious falls (3.5 percent against 8.5 percent) and fewer falls without injury (15.0 percent against 26.5 percent), while rates of overt encephalopathy and of death or transplant stayed close between the groups. The trial folded deaths, transplants, falls, and episodes of encephalopathy into one ranked measure, and on that measure the lactulose-then-tai-chi sequence came out ahead of enhanced usual care by a factor of 2.7.

Lactulose is a prescription medicine, so the conversation starts with your liver specialist. If you have cirrhosis and you have fallen, felt unsteady, or started avoiding the stairs, this trial gives you something concrete to raise at the visit.

Two days later, on September 18, the American Journal of Gastroenterology published a different form of evidence. 6 This was a cohort study of 85,554 adults in Korea, all recorded as having MetALD — liver disease with both a metabolic driver, such as fatty liver, type 2 diabetes, or excess weight, and an alcohol component. Each had completed three national health screenings between 2009 and 2014. Those screenings let the researchers group people by how their drinking actually moved over that stretch, and then follow them for a median of 10.1 years.

The three groups came out close to equal in size. About a third kept drinking at the same level (32.9 percent), about a third moved up and down (34.6 percent), and about a third reduced steadily (32.4 percent). Measured against the steady drinkers, the group whose drinking moved around had 20 percent fewer major liver complications, and the steady reducers had 30 percent fewer. The steady reducers also saw more of their early blood-sugar, triglyceride, and blood-pressure problems resolve.

This is an observational study, which shapes what you can take from it. It compared groups of people as their lives went on, in one country's national screening program, with drinking recorded at three points. What it shows is that both the size of the drop and how long it lasted tracked with liver risk over the following decade. If you have fatty liver disease and you drink, the practical step this week is to write down a typical week of drinks, honestly, and take that note to your appointment.

Ask at your next visit: "Given my liver results and how much I drink in a normal week, what would cutting back change for me, and what help is available to keep it down?"